The Canadian Perspective

The Canadian Perspective

Urology Team Video Q&A

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Overview of Urology

Overview of Urology

Introduction

Urologists are physicians that diagnose and treat diseases of the urinary tract in men and women and treat conditions involving the reproductive tract in men.

Urology is likely one of the oldest medical specialties and likely dates back to the time of ancient Egyptians and Greeks. There is evidence that suggest urology existed over 4000 years ago in ancient Egypt when surgical instrument used to treat urethral stricture were found at burial sites of the pharaohs. In ancient Greece, doctors which could be considered early urologists frequently examined urine’s color, odor, and texture looking for bubbles, blood, and other signs of disease.

Today urology has evolved substantially from its ancient origins and is a rapidly developing medical specialty focusing on the health of the urinary system and male genital system.

This video is a look at who urologists are, what we do, how we do it and why you should consider becoming a urologist as a rewarding career. This is made with input from many different urologists from across Canada.

Urologists are surgeons. Many of the diseases we treat have surgical options. For example, we frequently surgically remove cancers of the genitourinary system such as prostate, kidney, testes, and bladder and also commonly surgically repair blockages of the urinary tract such as in the case of kidney stones, urethral strictures or an enlarged prostate.

Although urology is a surgical specialty, urologists also have knowledge of internal medicine, pediatrics, gynecology and other specialties because of the wide variety of clinical problems we encounter. Many urologic conditions have medical treatments including erectile dysfunction, urinary tract infections, bladder dysfunction and prostate enlargement to name a few.

The Genitourinary System

The urinary tract is the organ system that creates, stores, and removes urine from the body. Urologists treat all parts of the urinary system including the:

  • Kidneys (the organs that filter waste out of the blood and produce urine)
  • Ureters (the tubes through which urine flows from the kidneys to the bladder)
  • Bladder (the hollow muscular sac that stores urine prior to urinating)
  • Urethra (the tube through which urine travels from the bladder out of the body)
  • Adrenal glands (the glands located on top of each kidney that release various hormones)

Urologists also treat all parts of the male reproductive system. Including the:

  • Penis
  • Prostate
  • Testicles
What diseases do urologists treat?

Urologists treat a wide variety of conditions that affect the urinary system of both sexes and male reproductive system.

Urology patients run the entire spectrum with patients of all ages, gender and socioeconomic status affected by urologic conditions. This is an inclusive range of patients

In men, urologists commonly treat:

  • Cancers of the bladder, kidneys, penis, testicles, adrenal and prostate glands
  • Prostate gland enlargement known as benign prostatic hyperplasia
  • Erectile dysfunction
  • Male infertility
  • interstitial cystitis and other bladder disorders
  • Kidney diseases and kidney stones
  • Prostatitis, which is inflammation of the prostate gland
  • Urinary tract infections (UTIs)
  • Varicoceles, or enlarged veins in the scrotum
  • Urethral Stricture

In women, urologists often treat:

  • Urinary incontinence
  • Bladder prolapse, or the dropping of the bladder into the vagina
  • Cancers of the bladder, kidneys, and adrenal glands
  • Bladder conditions such as interstitial cystitis and overactive bladder
  • Kidney and ureteral stones
  • Urinary tract infections

In children, urologists commonly treat congenital diseases that cause urinary blockage, infection or difficulties urinating

What surgeries do urologists perform?

To accurately diagnose patients with urologic disease, urologists perform a variety of tests including:

  • Imaging, such as a CT scan, MRI scan, PET scans or ultrasound
  • Contrast studies (“dye tests”) commonly of the bladder (aka cystogram), urethra (aka urethrogram) or kidneys (aka pyelogram).
  • Urologists commonly perform cystoscopy using a specific thin endoscope called a cystoscope to see the inside the urethra and bladder.
  • We also perform studies of the bladder and lower urinary system called urodynamics to assess function of these structures
  • We also order a variety of blood and urinary tests some of which are unique to our specialty.

Urologists are trained to perform different types of surgery. This often include performing:

  • Biopsies of the bladder, kidneys, or prostate
  • Cystectomy, which involves removing the bladder to treat cancer
  • Nephrectomy to remove kidneys for cancer or infection.
  • Extracorporeal shock-wave lithotripsy, which involves breaking up kidney stones so they can remove them more easily
  • Kidney transplants to replace a diseased kidney with a healthy one
  • Procedures to open urinary blockages to the urethra, bladder and ureter.
  • Repair of damage due to trauma
  • Repair of urinary organs that don’t develop properly.
  • Prostatectomy, which involves removing all or part of the prostate gland to treat prostate cancer. This is often done robotically.
  • Sling procedures to support the urethra and treat urinary incontinence
  • Transurethral resection of the prostate, which involves removing excess tissue from an enlarged prostate
  • Ureteroscopy, which involves using a scope to remove stones in the kidneys and ureter
  • Vasectomy to ligate the vas deferens as contraception to prevent pregnancy.
Urology Work Environment

Urologists work in a variety of settings, including hospitals, clinics, and ambulatory centers.

Approximately 70% of urologist in Canada work in a community setting while the other 30% identify as working in an academic environment.

Work Week: Urologists often have a varied work week which makes for an enjoyable work environment.  We spend time in the operating room for 1-2 days a week, 1-2 days in clinic, and other time spent doing procedures under local anesthetic such as cystoscopy or shockwave treatment of urinary stones. The average urologist in Canada works 56 hours per week including 28 hours of direct patient care, 8-10 hours of teaching, 6 hours of indirect patient care, and 1-3 hours of research, administration, professional development and practice management. Emergency care is typically less often a feature of urology compared to other surgical specialties but still do call to service the needs of our patients.

Gender: ~90% of urologists in Canada are male while 10% are female. The proportion of female urologists has been steadily increasing since 2003. Currently ~20% of the urologist under age 44 are female.

Income: In 2013, the majority (68%) of urologists in Canada were fee for service physicians while 8% were salaried with the remaining compensated in a blended manner.  In 2013/2014 the average gross clinical earnings for Urologists (for those earning at least $60,000) was $449,8262.

Satisfaction: As a result of great patients, effective surgeries, healthy income and great colleague’s urology has very high satisfaction rates with the majority of urologists satisfied with their job.

As the population ages and the prevalence urologic diseases increase there will be an increasing demand for urologists in Canada. Future job prospects look good.

Education and training requirements

After completion of medical school, to become a urologist in Canada requires a minimum of 5 years of Royal College-approved training. This period must include 2 years of core training in surgery and 3 years of approved residency training in urology one of which is a senior resident.

Senior residency is defined as a year in which the resident is regularly entrusted with the responsibility for pre-operative, operative and post-operative care, including the most difficult problems in urology.

The senior resident shall be in charge of a urological unit with no other resident intervening between the senior resident and the attending staff urologist.

At the end of their training, urologists must pass the specialty certification exam for urologists. The Royal College of Physicians and Surgeons of Canada certifies residents after successful completion of the exam.

Some urologists decide to do a year or two of additional fellowship sub-specialty training. During this time, you gain skills in a sub-specialty area.

Sub-specialties of urology

After residency training urologists may pursue 1-2 years of sub-specialty training known as a fellowship. Some of the subspecialties in urology are:

  • Pediatric Urology (children's urology)
  • Urologic Oncology (urologic cancers) which focuses on cancers of the urinary system, including the bladder, kidneys, prostate, adrenal and testicles
  • Renal Transplant
  • Male Infertility (which focuses on problems that prevent a man from conceiving a baby with his partner)
  • Endourology/Calculi - Endourology deals with the closed manipulation of the urinary tract most commonly for urinary stones. The field has grown to now include minimally invasive surgical procedures. Procedures are carried out using endoscopes inserted into the urinary tract and examples include prostate surgery, stone removal surgery and simple urethral or ureteral surgeries.
  • Female Urology (which focuses on conditions of a woman’s reproductive and urinary tract focused commonly on the
  • Neurourology which focuses on the nervous systems control of genitourinary organs)
  • Reconstructive Urology – focuses on restoring both structure and function to the genitourinary tract

What is Urology? (Canadian Edition)
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